6.5 Psychological support
Many clinicians will tell you that breastfeeding is a confidence game.
Prof Hartmann in his studies of breast growth and development from preconception to weaning noted one woman in their study had no breast changes during her pregnancy. She went on to successfully breastfeed her baby. Prof Hartmann commented that she was successful because no one at any time suggested to her that she might have a problem.
Similarly a woman who exclusively breastfed her triplets for 6 months said that she did it because no one told her she might not be able to, and that had it been suggested she probably wouldn't have had the confidence to even try.
Maternal self-confidence and self-efficacy
Researchers confirm self-confidence and self-efficacy to be major predictors of breastfeeding success. Women studied in Denmark,1 USA,2,3 Australia,4,5 New Zealand6 and Canada7 have all found mothers who have confidence in their ability to breastfeed and mothers with high breastfeeding self-efficacy significantly more likely to breastfeed.
Influencing self-confidence and self-efficacy
A lack of education about breastfeeding was identified by several of the researchers mentioned above.
Breastfeeding education needs to be included as a part of
- community awareness programs,
- prenatal classes,
- prenatal health care provider visits, and
- postnatally
Health professional attitudes and actions in regard to breastfeeding significantly influences mothers. At 12 weeks postpartum mothers are much more likely to be breastfeeding if they reported having received encouragement from their clinician to breastfeed2. Health care professionals can also have a negative influence if their lack of knowledge results in inaccurate or inconsistent advice. Some hospital routines are also potentially detrimental to breastfeeding7. Blyth et al (2002)5 recommend integrating self-efficacy enhancing strategies, improving the quality of healthcare delivered and increasing a new mother's confidence in her ability to breastfeed.
Support from the mother's partner or a nonprofessional greatly increases the likelihood of positive breastfeeding behaviors7.

Never underestimate the role of the father in supporting breastfeeding.
© WIC program, USA
Be aware at all times of how your seemingly innocent comments and actions can affect maternal confidence. For example: mothers have reported losing self-confidence to breastfeed from staff commenting about their 'flat' nipples, or small breasts, or red hair, or fair skin, or ability to hold the baby. Impatience is another factor identified by mothers trying to learn a new skill. Taking the baby from the mother and having him/her settle immediately demonstrates to a mother her lack of skill, and perhaps to an anxious mother, that the baby may 'prefer' someone else.
With such short hospital stays it's important for the mother to assume all care of her infant as soon as she is physically able to, with nurses or midwives available to coach her when needed, providing positive feedback at every opportunity.
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![]() Think positive. Sound positive.It's the little things that count. |
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What should I remember?
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Self-test Quiz
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Notes
- # Kronborg H et al. (2004) The influence of psychosocial factors on the duration of breastfeeding
- # Taveras EM et al. (2003) Clinician support and psychosocial risk factors associated with breastfeeding discontinuation
- # Chezem J et al. (2003) Breastfeeding knowledge, breastfeeding confidence, and infant feeding plans: effects on actual feeding practices
- # Creedy DK et al. (2003) Psychometric characteristics of the breastfeeding self-efficacy scale: data from an Australian sample
- # Blyth R et al. (2002) Effect of maternal confidence on breastfeeding duration: an application of breastfeeding self-efficacy theory
- # Vogel A et al. (1999) Factors associated with the duration of breastfeeding
- # Dennis CL (2002) Breastfeeding initiation and duration: a 1990-2000 literature review